RURAL  SCHOOL  HYGIOT3 

A  Section  of  the  Pennsylvania  Rural  School  Survey 
By  Professor  Louis  W.  Rapeer,  Pennsylvania  State  Cbllege 

—  v 

Jjl§.  Problem.  The  writer  of  this  seotion  of  the  survey  report  is 
new  to  the  state,  has  been  ever- burdened  with  other  duties,  and 
has  had  no  time  at  his  disposal  to  make  a  thorough-gjing  investi¬ 
gation  c.f  rural  school  hygiene  in  Pennsylvania.  Visits  with  a 
medical  inspector  to  a  few  schools  in  the  state,  traveling  in  many 
parts  of  the  state  where  rural  schools  could  be  seen  from  the  out¬ 
side,  conferences  with  county  superintendents ,  with  the 'State  Super¬ 
visor  of  Rural  School  Medical  Inspection  and  Sanitation,  and  with* 
the  State  Superintendent  of  Public  Instruction,  and  with  teachers 
at  institutes,  a  study  of  the  school  and  health  codes,  and  the 
generally  available  data  on  rural  school  hygiene  have  furnished  the 
immediate  basis,  for  the  following  generalisations  and  recommend¬ 
ations.  The  inadequateness  of  the  study  leads  to  the  first  recom¬ 
mendation  that  a  committee  be  appointed  by  the  Association  to  con¬ 
tinue  the  investigation  and  to  promote  educational  publicity  with 
respect  to  rural  school  health  improvement,  including  the  follow¬ 
ing  phases:  Medical  Supervision,  School  Sanitation,  Physical  Edu¬ 
cation  and  Recreation,  The  Teaching  of  Hygiene,  end  the  Hygiene 
of  Methods  of  Teaching  and  Management.  The  seriousness  of  the  pre¬ 
ventable  dea.th  and  illness  losses  of  the  peorJ  3  in  the  country 
districts’"  (Footnote.-  *  There  were  54,249  deaths  in  the  rural 
districts  of  Pennsylvania  in  1912,  probably  2d, 000  of  wh„,ch  were 
reasonably  preventable.^  as  well  as  the  pro  -alence  of  physical 
defectiveness  and  The  lack  of  recreation  make  further  study  and 
widespread  health  education  of  old  and  young  imperative. 

GENERAL  ADMINISTRATION 

Present  Rural  School  Health  Condition  s.  The  o ecords  of  our  State 
"Board  of  Heal  oh  show  {hat  the  problem” of  health  in  the  country  is 
as  serious  at  least  as  in  the  city.  In  fact,  he  difficulties  of 
promoting  health  and  normal  recreation  for  th  i  entire  population 
i'.n  the  rural  regions  o.re  in  several  ways  more  d  iff  ion;  i  that  in 
our  largest  cities.  The  recent  c  undies  of  Dr.  Thor..  D-  hod  and 
an  examination  of  the  returns  of  the  medical  and  sanitary  inspect¬ 
ions  of  the  rural  schools  of  this  state  indicate  nhat  the  health 
status  of  the  rural  school  pupils  is  no  better  than  that  of  ei  ’ey 
chnl.tlren  for  whom  there  have  been  collected  abundant  statistics. 

Where  there  hove  not  been  veritable  crusades  of  corrective  meas- 
%  ures  it  will  probably  be  found  in  any  one  school  year  that  about 
•»  ore- third  of  the  rural  school  children  are  free  from  serious  ail¬ 
ments  and  defects,  that  about  one-third  have  dental  defects  3nly, 
and  that  at  least  another  one-third  have  dental  and  other  defects 
of  a  more  or  less  serious  character  including  infectious  diseases. 

The  actual  findings  if  the  medical  officers  with  respect  to  the 
health  conditions  of  the  children  and  the  sanitary  conditions  of 


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the  rural  school  buildings  and  grounds  are  given  on  pages  and 
.  Data  with  respect  to  the  number  of  school  houses  in  good 
and  bad  sanitary  condition  are  given  «n  page  .  Yi/hile  the  avail¬ 
able  data  are  relatively  inaccurate  and  meager,  yet  we  must  con¬ 
clude  that,  considering  the  seriousness  of  the  large  preventable 
death,  illness,  and  physical  defectiveness  rate  and  the  opportun¬ 
ity  before  the  rural  school  to  ameliorate  conditions,  the  health 
and  recreational  facilities  of  the  rural  schools  are  on  a  low 
plane  of  efficiency,  not  as  low  as  many  states  but  low  enough  to 
warrant  the  serious  concern  of  all  oitizens,  and  especially  the 
health  and  educational  officials. 

Medical  and  Sanitary  Inspection.  The  State  Board  of  Health  furn¬ 
ishes  medical  and  sanitary  inspection  of  such  rural  schools  as 
are  not  exempted  by  a  majority  vote  of  rural  school  directors  and 
a  notification  to  the  State  Board  of  Health  before  the  firs';  of 
July  each  year.*  (Footnote — *  See  School  Code,  sections  1505-4. ) 

A  large  majority  of  the  rural  schools  are  now  using  this  service. 

In  this  they  are  ahead  of  most  rural  schools  of  the  nation,  com- 
X  .  ’.lively  few  of  which  have  even  the  primary,  onco-a-year  inspect¬ 
ion.  by  physicians.  Our  physicians  are  paid  six  dollars  a  year 
for  each  class-room  of  children  inspected  and  they  make  about  one 
vie  Lt  a  year  to  each  of  several,  schools,  sometimes  returning  to  a 
school  to  insnect  children  missed  at  the  firs*--  yiwit.  A  few  of  the 
more  altruistic  give  more  time.  The  average  amount  of  time  spent 
in  a  classroom  is  probably  near  two  to  three  hours.  The  physician 
sometimes  adds  to  his  medical  and  sanitary  inspections  through 
teaching  hygiene  by  means  of  a  short  talk  to  the  children  and  teach¬ 
er.  The  opportunity  in  the  field  of  preventive  medicine  is  great 
but  the  slary  is  very  small  and  the  social  ,  crvice  standards  of  the 
physician  are  frequently  not  much  above  those  of  the  trades-people 
with  whom  he  is  surrounded.  After  making  the  inspections,  a  report 
is  sent  to  the  State  Department  of  Health  which  later  notifies  par¬ 
ents  of  defects  found.  Complaint  is  made  that  these  reports  have 
ruached  paints  too  long  after  the  inspection  but  this  defect  is 
now  being  remedied.  Teachers  are  not  yet  Ising  supplied  with  a 
copy  of  the  report  of  uhe  defects  found  and  consequently  cannot 
wr  11  make  up  a  historical  record  card  for  each  pupil  nor  follow-up 
end  got  cured  the  ailments  found.  The  Department  of  Health  is  now 
planning  to  furnish  each  beacher  with  such  a  life  card  for  each 
pum LI,  to  contain  both  the  health  and  scholastic  record  tlrrougnout 
the  eight  grades  uf  school  life,  or  through  the  high  school.  The 
inspections  seem  fairly  well  done  considering  that  the  physicians 
have  received  no  special  training  for  the  work  and  have  practically 
no  supervision.  That  it  is  superficial  goes  without  saying,  bus 
fit  most  of  the  serious  ailments  and  defects  are  found  is  fairly 
certain.  The  merits  and  demerits  of  the  system  are  about  as  folia  vs. 

Merits 

1.  It  is  a  start  toward  better  things. 

£.  ft  brings  to  the  attention  of  parents  probably  ninty  per  cent, 
of  the  serious  ailments  and  defects  of  children. 

3.  It  calls  the  attention  of  teachers  and  pupils  each  year  to  the 


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importance  of  health  and  correction  of  defects. 

4.  It  discloses  certain  had  conditions  of  sanitation  and  fre¬ 

quently  gets  them  improved. 

5.  It  has  given  us  a  health  and  sanitary  survey  of  the  rural 

schools,  setting  forth  more  or  less  accurately  the  actual 
conditions. 

6.  It  has  aroused  a  small  percentage  of  parents  to  a  sense  of 

their  responsibility  for  caring  for  the  health  of  their 
children  through  preventive  and  remedial  measures. 

Demerits 

1.  It  succeeds  in  collecting  many  statistics  of  pathological  con¬ 

ditions  hut  fails  quite  largely  in  getting  cures,  cor¬ 
rections  and  preventive  measures. 

2.  The  inspections  are  entirely  too  infrequent,  thus  failing  to 
meet  the  problem  of  epidemics  of  infectious  diseases. 

3.  Inspection  is  not  mandatory,  by  law,  as  it  is  in  first,  second, 

and  third  class  districts  and  in  other  entire  states. 

4.  The  system  fails  to  provide  corrective  agents  and  measures, 

such  as  nurses  with  large  powers  and  clinics,  and  fails 
to  enforce  either  sanitary  or  medical  recommendations 
upon  school  directors  and  parents,  even  in  so  simple  a 
matter  as  vaccination. 

5.  Probably  the  greatest  weakness  is  in  the  meager  sco;-e  and 

quality  of  educational  publicity  along  wealth  lines. 

Rural  people  are  isolates  and  conservative.  "They  must 
be  shown, ”  Educate  the  people  and  they  will  more  gener¬ 
ally  respond  to  the  recommendations  of  the  physicians. 

The  department  could  Y/ell  use  fifty  or  more  lecturers  to 
meet  the  people  in  a  modern  way  at  the  rural  school  social 
centers.  The  school  department  is  likewise  weak  in  this 
respect.  Teachers  do  not  do  what  they  can  to  learn 
mere  and  to  do  more  along  school  health  lines.  The  key 
to  school  healtn  progress  is  school  health  public!  by, 

6.  In  this  connection,  the  department  is  very  weak  in  not  hav¬ 

ing  several  trained  rural  school  nurses  for  each  county. 
ITurses  have  so  far  proved  the  most  efficient  and  economical  em 

cational  agents  in  cities  and  they  hrve  proved  very  effect¬ 
ive  in  the  rural  parts  of  other  state  .  The  department 
is  contemplating  a  trial  of  rural  school  nurses. 

7.  The  system  is  not  a  part  of  the  educational  department  of  the 

state  in  any  direct  way.  The  physicians  are  looked  uuon 
as  outsiders  and  are  not  given  the  support  they  would  re¬ 
ceive  were  they  employed  by  the  county  superintendents 
or  the  State  Department  of  Instruction.  Medical  and  san¬ 
itary  inspection  are  not  made  an  organic  part  of  eduor tion- 
hygiene  and  the  isolation  of  the  parts  is  a  serious  cause 
of  inefficiency. 

8.  The  physicians  are  employed  on  -part-time.  School  medical 

inspection  is  for  "them  a  side-issue,  a  thing  to  be  done 
not  as  a  Mfe  work  and  a  speciality  but  as  a  moons  of 
taking  in  a  little  extra  money  when  patients  are  few. 

There  is  no  opportunity  to  specialize  in  this  new  and 
technical  type  of  work,  except  for  the  one  supervisor  in 
the  State  Board  of  Health  office  at  Harrisburg,  Dr.  Royer. 


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in  2017  with  funding  from 

University  of  Illinois  Urbana-Champaign  Alternates 


https://archive.org/details/ruralschoolhygieOOrape 


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1  Permanent  Solution.  School  health  work  must  he  treated  as 
a  whole  with  at  least  these  five  divisions:-  Medical  Supervis¬ 
ion,  School  Sanitation,  Physical  Education,  The  Teaching  of 
Hygiene,  and  the  Hygiene  of  Methods  (of  Teaching  and  Management). 
The  isolation  of  these  phases  and  the  lack  of  officials  respons¬ 
ible  for  the  whole  health  field  ore  now  the  most  important 
causes  of  school  health  inefficiency. 

To  effect  this  organization  and  unity  of  endeavor,  and  to 
promote  financial  and  human  economy,  the  state  administration 
of  medical  and  sanitary  supervision  must  he  in  the  hands  of  the 
State  Department  of  Public  Instruction;  the  county  administra¬ 
tion  must  he  carried  on  by  the  county  superintendent  and,  if 
provided,  by  the  county  board  of  education.  Such  organization 
would  make  possible  the  employment  of  a  supervisor  of  hygiene 
for  each  county  and  a  corps  of  school  nurses  to  take  the  place 
of  the  part-time  physicians.  Pour  to  six  school  nurses  to  a 
county  on  full  time  under  the  supervision  of  a  physic ian~phy- 
sical-educator  on  full  time,  all  under  the  general  administration 
of  the  county  and  state  educational  departments,  would  accom¬ 
plish  probably  a  thousand  times  more  for  the  improvement  of 
rural  life  and  rural  schools  than  the  present  arrangement,  and 
more  than  a  similar  amount  of  money  spenv  along  present  linos 
would  bring  about.  The  State  Department  of  Instruction  would 
thus  be ' enabled  to  employ  an  educational  hygienist  to  supervise, 
inspire,  and  promote  not  only  health,  physical  development,  end 
recreational  agencies  in  the  country  (fourth  class  districts) 
but  in  districts  of  the  first,  second,  end  third  classr  All 
districts  need  such  help  and  stimulus.  Medical  inspection  has 
been  taken  out  of  the  hands  of  boards  of  health  in  Hew  York,  Hew 
Jersey,  and  Massachusetts,  and  to  a  considerable  extent  in  Penn¬ 
sylvania;  three  of  the  above  states  will  soon  have  educational 
hygienists  in  the  state  educational  departments  for  general 
supervision  of  the  physical  and  he:  1th  side  of  the  education 
of  children  so  long  neglected;  and  Pennsylvania  should  proceed 
along  the  same  line  of  evolution. 

In  a  county,  the  supervisor  of  educational  hygiene  should 
take  the  rank  of  an  assistant  county  superintendent.  His  salary 
should  be  not  less  than  $2,000  for  full  time.  Assisting  him. 
there  should  be  in  each  county  a  number  of  district  nurses, 
each  nurse  taking  as  many  schools,  regardless  of  townsh.ip  lines, 
as  possible,  probably  not  more  than  fifty  classrooms  to  begin 
with.  Rural  school  nurses,  with  their  Fords  and  buggies,  are 
now  doing  superior  work  for  rural  health  in  a  number  of  states. 
Four  nurses  to  a  county,  as  a  beginning,  with  salaries  at  ti'ChOG 
a  month  would  cost,  for  eight  months  a  year,  $2,240,  not  <  cant¬ 
ing  supplies  nor  the  use  of  conveyances  if  provided  by  the 
county.  The  cost  would  bo  about  equivalent  to  the  silavi.es  of 
two  assistant  county  superintendents ,  and  should  be  borne  by 
state  and  county  appropriations.  This  is,  ultimately,  the  most 
convenient,  efficient,  and  economical  organization.  -bulled 


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nurses  under  supervision,  working  as  regular  school  officers, 
ore  the  most  effective  means  of  translating  pathological  statis¬ 
tics  into  cures,  corrections,  and  prevention  of  disease.  The 
work  of  the  supervisor  would  be  to  lead  and  to  direct  all  school 
health  work  along  the  lines  of  the  teaching  of  old  and  young  the 
tfwao/s  and  means  to  health  and  joyous  living#  He  would  use  the 
/rural  school  as  a  health  social  center,  meeting  the  parents  fre- 
q uently  at  such  centers;  he  would  organize  md  promote  the  -ley 
land  recreational  activities  of  the  schools  and  oonimunities;  he 
would  help  get  schools  and  grounds  into  sanitary  condition;  he 
would  help  bring  about  consolidation  and  transportation  of  pupils 
where  desirable;  he  would  help  examine  the  children  medically  and 
physically;  he  would  help  get  cures,  corrections,  and  preventive 
measures  for  ailments  and  defects  found;  he  would  establish  and 
manage  "flying"  or  traveling  clinics  for  treating  and  prescrib¬ 
ing  for  moor  children;  he  would  train  the  nurses  and  teachers  for 
their  work. 

Legislation  would,  of  course,  be  necessary  to  provide  such 
organization.  The  enormous  preventable  death,  illness,  end  phy¬ 
sical  defects  losses  of  the  rural  population,  probably  not  loss 
than  forty  million  dollars  each  year  when  estimated  m  money,  make 
imperative  a  more  energetic  and  civilized  method  of  ameliorating 
disgraceful  health  conditions. 

IMPROVING  TEH  PRUSRNT  ORGANISATION  OF  RURAL  307X001,  HfCrlUNT 

If  a  thorough- going  reorganization  of  rural  school  health 
work  is  not  at  present  feasible  ,  much  can  at  least  be  done  in 
improving  the  present  system.  The  State  Board  of  Health  must 
have  much  larger  appropriations  for  this  work  so  it  can  introduce 
school  nurses  and  other  improvements;  the  provision  of  medical 
and  sanitary  inspection  must  be  made  mandatory  for  all  school  dis¬ 
tricts;  teachers,  principals,  and  enunty  superintendon  bo  must 
have  a  much  improved  training  along  the  lines  of  oduo.o  bional  hy¬ 
giene  before  and  while  in  service;  and  the  work  of  rhe  nl;ato  De¬ 
partment  of  Instruction  along  the  lines  of  school  health  work 
must  be  greatly  extended. 

Tlie  State  Department  of  Public  Instruction.^  The  State  Deportment 
of  Public  Instruction  should"  have"  on  its  staff  an  educa  tional  hy¬ 
gienist  who  would  help  the  Department  to  educate  the  ueople  with 
res-ect  to  healthful  living,  including  the  teachers  and  ^unils, 
to  supervise  the  work  to  some  extent,  to  enforce  health  measures, 
and  to  put  back  into  schooling  what  has  been  ommitted  since  the 
time  of  the  Greeks.  Further  suggestions  are  as  follows 

1.  The  state  department  should  begin  at  once  to  furnish  bulletins 
on  the  various  phases  of  health  work  such  as  play  and  playgrounds, 
school  sanitation,  standardization  of  rural  schools,  the  teach¬ 
ing  of  hygiene,  the  teacher Ts  responsibility  for  medical  inspect¬ 
ion  and  fo'llow-um  of  school  children,  etc.  ,  such  as  are  furnished 
to  all  rural  teachers  in  Oregon,  Virginia,  North  Carolina,  and 
other  states.  These  should  be  well  illustrated,  printed  in  large 
attractive  tyne ,  and  written  in  succinct,  readable  stylo. 

2.  I u  should  make  the  course  of  study  in  hygiene  for  elementary 
and  high  schools  ns  helpful  both  as  to  content  and  method  as 

possible. 


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So  It  should  v)lace  on  the  list  of  required  reeding:  for  teachers 
such  "books  as  Hoag  and  Terman’s  recent  volume  on  "Health  Work  in 
the  Schools"  and  Curtis’  "Play  and  Recreation  in  the  Open  Ceuu-- 
try.  " 

4.  The  school  code  should  "be  "bolstered  up  in  sanitary  and  other 
health  requirements,  and  the  penalties  for  not  complying  with 
the  law,  such  as  removal  from  office  by  the  State  Superintendent, 
and  by  withholding  appropriations  should  be  increased.  These 
powers  should  be  frequently  used  until  new  standards  are  estab¬ 
lished. 

5.  Models  of  rural  schools  of  vo.rious  sizes,  including  consol¬ 
idated  schools,  should  be  made  in  cardboard  or  other  material  and 
loaned  to  directors,  institute  lecturers,  and  county  superintend¬ 
ents,  Printed  plans  and  photographs  of  desiro/ble  buildings 
should  be  sent  broadcast  to  elevate  the  standards  of  what  the 

rural  school  plant  should  be.  Standards  and  premiums  in  the 
shape  of  door  plates  or  certificates  should  be  set  up.  Descript¬ 
ions  of  the  great  development  of  consolidated  schools  would 
klip  in  the  same  direction. 

6  School  health  exhibits  should  be  made  up  by  the  state  deport¬ 
ment  and  sent  out  to  institutes,  normal  schools,  directors'*  meet¬ 
ings,  and  other  places  to  raise  standards  along  all  lines  of 
school  hygiene. 

7,  It  should  also  furnish  health  bulletins  and  news  items  to 
teachers,  news  agencies,  directors,  superintendents,  and  others 
as  the  U.  1.  Bureau  of  Education  is  now  doing. 

8.  The  State  Department  of  Health  should  be  "backed  upIT  by  ail 
the  n ewers  of  the  State  Department  of  Public  Instruction 

C5 parity.  Administration.  Even  with  the  general  administration  of 

medic? 1  and  sanitary  inspection  in  the  hands  of  the  State  Boa’s: 
of  Health,  a  great  work  remains  to  be  done  in  each  county,  \<v  .  1 
school  nurses  should  by  some  means  be  provided,  They  may  well 
be  under  the  supervision  of  the  county  superintendents  cl  no 
county  hygienist  is  provided.  The  State  Bo arc.  of  Heal  kh  mig  t 
meet  the  situation  by  uniting  the  offices  of  county  heal  Lb  of¬ 
ficer  and  county  school  hygiene  supervisor,  such  a  man  on  full 
time  and  with  a  good  salary  could  do  for  run  ..l  health  a  great 
public  work.  The  difficulty  would  be  in  getting  firsu-clasa 
officials  and  the  right  kind  of  co-operation  between  couuby 
super in tenden bs  with  their  many  teachers  and  the  school  and 
health  officer*  This,  however ,  seems  to  be  the  logical  and  econ¬ 
omical  stem  in  advance  with  the  start  we  have  taken. 

County  superintendents  should  report  on  the  health  condom 
ions  uf  Uheir  counties  as  city  superintendents  do  and  iiurr  hi  cal  ! 
use  every  means  to  help  and  co-operate  with  the  health  officials- 


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3. 


The _ Stt  te  School  Law.  The  following  suggestions  are  offered 
for  improving  the  school  laws  with  reference  to  rural  school 
hygiene :- 

1.  Hake  medical  and  sanitary  inspection  in  f ourth-class  dis¬ 
tricts  mandatory  instead  of  permissive  ns  at  present. 
Provide  for  more  universal  enforcement  of  the  vaccination 
law.  It  is  now  largely  a  dead  letter  in  rural  schools 
in  many  parts  of  the  state.  The  State  Commissioner  of 
Education  of  New  York  is  using  his  power  of  removing 
school  directors  from  office  for  non-compliance  with  this 
law.  State  school  appropriations,  amounting  to  about 
•$75,00  for  each  teacher  and  $1.80  for  each  pupil  in  the 
district  between  the  ages  of  six  and  sixteen  inclusive, 
should  be  withheld  for  non-compliance  with  certain  defin¬ 
ite  laws  such  as  those  for  vaccination,  jacketed  stoves, 
proper  lighting,  suitable  outbuildings,  provision  of 
drinking  water,  etc.  More  effective  educational  publicity 
will  obviate  very  frequent  recourse  to  such  measures. 
Section  616,  respecting  the  preparation  and  free  distribution 
*£  plans  for  model  soho-ol  buildings  by  the  State  Board  of 
''Pd.uca^ioii,  is  a  very  good  law  but  it,  is  not  being  followed 
up  very  effectively.  Prowisiond  for  educating  the  public, 
especially  teachers  and  school  directors,  as  to  the  desir¬ 
ability  of  improved  standards  for  the  rural  school  plants 
(buildings  and  grounds)  should  be  increased. 

Section  618,  respecting  the  provision  of  a  lighting  area  equal 
to  at  least  one-fifth  of  the  floor  area  and  no  light  from 
the  front,  should  be  amended  to  require  also  a  preponder¬ 
ance  of  lighting  area  #n  the  left  of  the  pupils  as  seated 
at  their  desks  and  to  provide  for  automatic  withholding 
of  state  appropriations  from  each  school  in  use  after 
January  first,  1916  that  is  not  in  conformity  with  the 
law.  A  rural  school  in  Columbia  County  recently  added 
two  windows  on  each  side  of  a  rural,  •ne-room,  brick  school 
at  a  cost  of  only  $30.00.  Two  windows  added  to  the  left 
of  the  pupils  v/ould  have  given  e  lighting  area  equal  to 
more  than  one-fifth  «f  the  floor  area  and  a  preponderance 
of  light  from  the  left.  The  cost  of  such  changes  is 
evidently  insignificant,  considering  the  improvement  in 
the  cheer  of  the  class-rooms  and  the  lessening  of  eye- 
strain  which  now  increases  progressively  upward  through 
the  grades  of  school  life. 

be  amended  t*  require  an  average  temper¬ 
ature  in  schools  of  68J n Ahead  of  7i  degrees  Fahrenheit 
Section  62^  should:  frfbTTTcTe'  for  a  hygrometer  in  each  school 
building  as  well  as  a  thermometer  in  each  classroom.  Re¬ 
cent  investigations  which  indicate  that  neither  insuffic¬ 
iency  of  oxygen  nor  increase  of ^carbon  dioxide  are  import- 


y 

76., 


-8- 


ant  factors  in  ventilation,  lead  to  an  emphasis  on  humidity,  nr 
percentage  of  moisture  in  the  air,  in  school  ventilation. *  (Foot¬ 
note  See  Hill's  pamphlet  nn  "The  Relation  of  the  Atmosphere 
to  ^ur  Health"  published  by  The  Smithsonian  Institution,  Wash¬ 
ington,  D.  0.  and  Termcn's  chapter  on  "The  Physiology  of  Vent¬ 
ilation"  in  his  book  on  "The  Hygiene  of  the  School  Child.") 

All  teachers  teach  that  oxygen  and  carbon  dioxide  are  the  princi¬ 
pal  factors  but  the  important  factors  really  seem  to  be:  percept¬ 
ible  movement  «f  the  air,  proper  temperature  (around  68  degrees), 
suitable  percentage  of  moisture  in  the  air,  4^  to  7*  per  cent, 
and  elimination  of  disease  germs,  especially  the  first  three.  A 
direct  reading  hygrometer  such  as  the  small  "hair  hygrometer" 
with  thermometer  attached  or  the  "precision  hygrometer"  with  a 
face  like  an  alarm  clock  and  the  hair  well  protected  should  be 
usee1.  (Footnote:-  *  May  be  purchased  from  the  Central  Scienti¬ 
fic  Supply  Co.,  Chicago  or  other  dealers  for  five  to  seven  dol¬ 
lars  each.  The  prices  seem  variable.  )  With  such  an  instrument 
a  teacher  can  tell  the  percentage  of  moisture  as  easily  as  she 
can  tell  the  time  by  a  clock.  When  the  moisture  in  the  room  goes 
below,  forty  per  cent  *f  saturation,  she  can  (a)  open  windows  to 
let  in  outside  air,  (b)  put  water  into  the  receptacle  for  such 
rrumose  os  provided  with  jacketed  stoves,  or  (c)  place  a  pan  or 
pans  of  water  on  the  stove  or  radiators,  fin  days  when  the  humid¬ 
ity  is  well  above  forty  per  cent  no  water  need  be  used.  When 
teachers  or  pupils  have  to  carry  water  from  farm  houses  up  to  a 
mile  away  this  would  be  a  saving  of  energy  during  a  large  part 
of  the  year.  The  excessively  dry  air  is  very  harmful  and  many 
schoolrooms  have  sir  as  dry  as  the  deserb  of  Sahara,  and  dryer, 
much  of  the  time  when  the  room  is  being  heated  artificially. 

Windows  may  be  used  to  orovide  a  distinct  movement  of  the 
air.  Window  boards  or  glass  should  be  used  to  keep  strong 
drafts  off  the  nunils  near  the  windows.  Some  teachers  fail  to 
keen  the  fresh  air  vent  into  the  jacket  of  the  stove  «pen  at  all 
times.  This  should-  be  prevented  in  most  cases,  perhaps,  by 
making  it  impossible  to  close  the  vent  at  ail. 

7.  Section  624  should  be  amended  to  provide  not  only  that  all 
doors  of  schools  should  open  outward  but  that  all  such  doors 
should  always  be  unlocked  while  schools  are  in  session.  It  is 
common  to  see  tw#  doors  together  (double  doors)  in  village 
schools,  with  one  of  the  do*rs  locked  shut  at  all  times.  Such 
doors  should  be  provided  with  panic  bolts  which  open  the  doors 
by  slight  pressure  by  a  small  child.  Many  of  the  17?  children 
who  were  burned  to  death  in  the  Collinwood  (Cleveland)  fire  lost 
their  lives  because  there  was  no  panic  bolt  on  one  «f  the  double 
doors  so  it  could  be  opened  outward. 

8.  A  section  should  be  provided  to  insure  plenty  of  fresh  drink¬ 
ing  water  on  the  school  grounds  at  all  times  while  schools  are"* 


.  ‘ 


, 


/ 


-9~ 


in  session,  and  to  provide  that  where  water  is  not  obtainable 
at  a  distance  of  a  hundred  yards  from  the  school  grounds  that 
the  directors  be  required  to  haul  fresh  water  to  the  school  daily 
or  provide  a  well  on  the  grounds.  Where  the  expense  of  providing 
several  wells  in  a  district  is  great  it  may  be  f^und  more  desir¬ 
able  to  establish  a  consolidated  school.  (County  administra tion 
and  consolidation  of  schools  are  both  irmortfnt  factors  in  school 
health  or ogress . ) 

The  Health  Education  of  .Teachers.  The  courses  in  general  hy¬ 
giene  in*  our  elementary  and  high  schools  should  be  improved  in 
the  direction  #f  more  time,  better  teachers,  and  better  texts. 
Practical  personal,  public,  community,  and  occupational  hygiene 
should  be  taught,  not  merely  for  giving  health  information  but 
for  developing  workable  health  ideals  and  habits.  The  large 
number  of  persons  going  directly  from  the  high  schools  to  the 
classrooms  as  teachers  may  well  have  special  training  along  the 
line  of  school  hygiene  in  the  high  schools. 

For  the  graduates  of  our  normal  schools  t*  go  out  as  rural 
school  teachers  without  a  thorough-going  study  of  rural  life  and 
education  and  a  similarly  thorough  course  in  rural  school  hygiene 
is  little  short  of  criminal,  considering  the  demonstrable  needles* 
deaths  and  illnesses  due  tj  ignorance  of  practical  school  hygiene 
on  the  part  of  the  teachers.  The  simple  essentials  of  medical 
su--  ervision,  school  sanitation,  physical  education,  the  teaching 
of  hygiene,  and  the  hygiene  of  methods  of  teaching  and  man  ago men  c 
can  be  treated  in  a  course  one  term  in  length,  meeting  five  hour;; 
a  week,  and  this  should  be  a  required  minimum.  Hoag  and  Terman ' s 
"Health  Work  in  the  Schools"*  (Footnote:-*  See  list  at  end  of 
this  section.)  cover  three  of  these  phases.  Curtis'  book  on 
"Play  end  Recreation  in  the  Open  Country"  deals  with  physical 
education,  including  play  and  recreation.  Dressier1 s  book  *n 
"School  Hygiene"  is  devoted  largely  to  school  sanitation.  No  one 
book  covers  all  five  divisions  except  "Educational  Hygiene"  be¬ 
ing  published  by  Scribner’s  for  the  writer,  which  is  rather  large 
for  a  normal  school  class  perhaps#  Gillette’s  "Constructive 
Rural  Sociology"  end  the  various  books  on  rural  life  and  rural 
education  named  on  page  give  many  helpful  suggestions  along 
the  lines- of  practical  educational  hygiene  in  the  home  and  in  th* 
school . 

_The  Teacher  ’  s  Own  Health  is  of  supreme  importance  in  education. 

In  their  professional  training  and  while  in  service  they  should 
be  acquainted  with  the  facts  regarding  the  health  of  teachers, 
such  83  are  given  in  Terraanrs  "The  Teacher’s  Health"  and  else¬ 
where.  Teachers  as  a  class  have  more  of  tuberculosis,  nervous 
ness,  and  ailimentary  diseases  than  the  average  population.  Ev 
thing  possible  should  be  done  to  make  them  healthy,  vigorous, 
and  joyous,  as  becomes  those  whose  work  is  with  children  and.  wKt 
as  public  officials  of  the  state  must  be  held  responsible  as  gu 
guo.rdians  of  the  public  health. 

Teachers  should  be  medically  examined  each  year  by  the 
physician  who  makes  the  medical  examinations  of  the  school 


~  ^  *,  .  . 


•  .  • 


-f-t 


■ 


-  •  = 


/ 


-10- 


/  children.  At  present  a  teacher  in  any  state  of  ill-health,  it 
seems,  can  obtain  the  health  certificate  that  is  required  each 
yjear.  For  the  purpose  of  learning  of  incipient  ailments  each 
•Jjeacher  should  on  her  #wn  initiative  ask  to  be  examined  each 
/year  by  the  examining  physician.  It  is  a  right  and  a  privilege. 
j The  life  Extension  Institute  ®f  New  York  is  now  examining  thous¬ 
ands  of  employees  of  industrial  concerns  for  employers,  without 
j  expense  to  the  employees,  for  the  purpose  of  increasing  their  in- 
'  dustrial  efficiency.  (Footnote:-*  See  article  by  R&weer  in 
Educational  Review  for  December,  1914.)  The  state  has  an  even 
greater  warrant  and  obligation  with  respect  to  its  public  of¬ 
ficials  in  the  public  schools. 


Every  teacher,  m©re©ver,  should  have  an  avenue  of  appeal  that 
will  prove  effective  when  she  finds  herself  immured  in  a  school 
plant  that  is  unsanitary  and  injurious  to  her  health.  An  appeal 
either  to  the  State  Department  ©f  Public  Instruction,  the  S  ka  r;e 
Department  of  Health,  or  t«  a  committee  of  the  State  Educational 
Association  should  bring  prompt  and  effective  relief  frcm  such 
conditions  without  Jeopardy  to  her  tenure  of  office. 


It  may  be  f#und  desirable  to  provide  teachers  with  social 
insurance  against  sickness  and  injury  while  at  their  work. 


Schoel  Health  Handbooks.  A  selected  group  of  school  health  hand¬ 
books  for  teachers,  superintendents,  physicians,  and  nurses  is  as 
f  allows : - 

Allen,  "Civics  and  Health” 

Bancroft,  "lames  f©r  Playground,  Home,  School,  and  Gymnasium." 
Cabot,  "Volunteer  Work  in  the  Schools." 

Burk,  "Health  and  the  School." 

Coleman,  "The  Peoplers  Health,"  for  upper  grades  and  high  schools, 
Cornell.  "Health  and  Medical  Inspection  of  School  Children.” 
Cruickshank,  "School  Clinics.” 

Curtis,  "Play  and  Recreation  in  the  Oven  Country," 

Chisholm,  "The  Medical  Inspection  of  Girls  in  Secondary  Schools." 
Denison,  "Helping  Scho©l  Children." 

Hitman,  "Home  Hygiene  and  the  Prevention  of  Disease,"  for  home 
and  school. 

Foster,  "The  Social  Emergency,"  a  botk  on  sex  education  and  hygierw 
Gulick  and  Ayres,  "Medical  Inspection  of  Schools." 

Gulick  series  of  hygiene  texts  for  elementary  schools. 

Hoag  and  Terman,  "Health  Work  in  the  Schools.” 

Johnson,  "Education  by  Plays  and  Games." 

Raneer,  "Educational  Hygiene,"  fin  press) 

Pwaoeer,  "School  Health,"  a  hanbook  for  teachers,  fin  preparation, 
Rapeer,  "School  Health  Administration." 

Ra^'eer,  "The  Administration  of  School  Medical  Inspection." 

Ritchie  hygiene  series  f#r  elementary  schools. 

Perry,  "The  Wider  Use  of  the  School  Plant." 

Sill,  "The  Child,"  go*d  f©r  the  home  as  well  as  .lower  grades  in 
school. 

Terman,  "The  Teacher rs  Health." 


"**>*■  •'■•**;■  ■  •  •  »*-.=  .A^v.  ;• 


•••^  “  -.}.%•  V  ■■■•■■  ■■'■&  ~V»  "*■: 


'  AS' 


‘.SPfW 


-11- 


Terman,  "The  Hygiene  #f  Instruction"  fin  preparation) 

Ter man ,  "The  Hygiene  tf  the  School  Child." 

Tolman,  "Hygiene  Tor  the  Worker." 

Wood,  "School  Sanitation."  fin  preparation) 

Besides  these  books  there  are  many  free  pamphlets  issued 
by  the  United  States  Bureau  of  Education  and  by  various  state 
boards  of  health  and  boards  of  education,  procurable  for  the 
asking.  Kingsley’s  book  on  oven  air  schools,  entitled  "Open 
Air  Crusaders"  may  be  obtained  free  of  charge,  or  for  the  post¬ 
age,  from  The  Elizabeth  McCormick  Memorial  Fund,  Chicago.  Any 
teacher  can  build  up  a  free  library  on  most  phases  of  education¬ 
al  hygiene  for  her  school  or  herself  with  little  trouble. 

Some  miscellaneous  recommendations  growing  out  of  visits  to 
rural  schools  and  conferences  with  medical  officers  and  county 
superintendents  follow* 

Medical  Supervision.  Sufficient  suggestions  have  been  made  in 
this  field  perhaps  for  this  time.  Hoag,  in  his  bulletin  on 
"Organized  Health  Work  in  the  Schools"  shows  how  teachers  may 
learn  to  discover  over  ninty  per  cent  of  the  ailments  and  de¬ 
fects  of  their  children.*  (Footnote:-*  Government  Printing  Of¬ 
fice,  Washington,  D.  C. ,  price  ten  cents.  The  substance  of  this 
bulletin  is  also  in  his  "Health  Work  in  the  Schools.”)  Teachers 
can  also  do  very  much  by  daily  health  questionnaires  and  heme 
visiting,  almost  equalling  a  good  school  nurse  in  getting  cures 
and  treatments  of  ailments  found.  While  physicians  and  nurses 
are  not  at  the  school,  teachers  must  be  held  responsible  for  de¬ 
tecting  infectious  diseases.  Hoag's  symptom  charts  will  help 
in  this.  By  use  of  the  rural  school  as  a  social  center  parents 
may  be  taught  directly  by  stereopticon  and  other  lectures. 

State  College  is  preparing  slides  for  such  use-  to  loan  to  schools. 
The  Russell  Sage  Foundation  of  Hew  York  will  loan  slides  on  play¬ 
grounds,  medical  inspection,  and  other  similar  topics.  Visit¬ 
ing  nurses'  associations  end  rural  Y.  H.-  C.  A.'s  may  fften  be 
appealed  to  successfully  for  the  loan  of  medical  tr  playground 
workers. 


School  Sanitat i#n._  The  demand  for  unilateral  lighting  of  schools 

has  probably  gone  to*  far.  Unilateral  lighting  eommcnly  means 
unilateral  windows,  and  windows  on  one  side  of  the  classroom,  or 
even  st  left  and  rear,  mean  that  the  opportunity  f#r  perceptible 
air  currents  in  the  room  is  cut  off.  The  shadows  of  the  pupil’s 
hands  on  their  writing,  on  the  right  side  of  the  room-  are  prob¬ 
ably  insignificant  in  injurious  effect  as  compared  with-  insuf¬ 
ficient  ventilation,  especially  in  one—  room  rural  schools,  and 
especially  when  the  ventilating  apparatus  is  poor  or  is  not  in 
use.  By  cutting  two  or  three  windows  more  through  the  left  wall 
of  the  one-room  school  and  leaving  the  present  windows  on  the 
right  for  illumination  and  ventilation  mos’c  rural  sohools  can 
be  given  glass  space  equal  to  one-fourth  of  the  floor  space,.  a 


-  .<*■> 


/ 

.  -' 


•  **»#»* 

-■  -*KU&*P 


-  •••,  .  •.  S"W 


-  e«.  ' 


-12' 


desirable  proportion  for  a.  room  twenty- three  t#  thirty  feet  in 
width.  Schools  with  halls  should  els*  have  windows  -jri  the 
right  tf  punils,  for  light  and  ventilation.  High  single  sash 
on  oivots  are  satisfactory. 

Cr^-ss  ventilation  may  he  secured  by  the  use  *f  window  boards, 
about  five  inches  in  width,  the  width  of  the  window  sash,  and 
sowed  in  two  and  fastened  together  by  a  hinge  to  make  removal 
easy.  Such  a  board  can  be  made  in  twenty  minutes  by  any  handy 
school  boy  of  the  u-oper  gra.des,  and  moreover  furnishes  first- 
class  manual  training  work.  The  board  should  be  inserted  be¬ 
neath  the  sash  leaving  the  air  to  come  in  between  the  sashes  at 
the  middle  of  the  window.  Wider  boards  at  the  bottom  cut  out 
too  much  light.  One  or  more  such  boards  should  be  used  with 
even  the  best  tyres  of  jacketed  stoves,  I  believe.  During  mild 
and  warm  weather  the  room  should  be  made  an  open  air  school, 
children  keeping  their  wraps  on  when  necessary. 

Dark  green  window  shades  seem  almost  universal  in  rural 
schools  but  they  should  never  be  used  exceot  frr  the  use  of  lant¬ 
erns  in  the  day-time.  Many  teachers  have  the  bad  habit  of  keep¬ 
ing  shades  drawn  half  way  even  on  cloudy  days,  thus  cutting  rff 
more  than  half  of  the  light.  Shades  should  be  light  tan  in 
color  and  should  be  translucent,  cutting  off  the  blinding  rays 
of  the  sun  but  permitting  enough  light  to  shine  through  to  keep 
the  room  well  illuminated.  Dark  shades  frequently  make  a  room 
cave-like  when  shades  are  nulled  down  t§  cut  out  the  direct  rays 
of  the  sun.  The  injury  done  by  careless  teachers  who  leave 
shades  pulled  down  when  the  sun  is  not  shining  in  is  lessened 
by  the  use  of  such  light  colored  translucent  shades.  The  Luther 
0.  Draper  adjustable,  translucent,  cloth  shade  as  used  in  the 
high  school  building  at  State  College  seems  to  fulfill  most  con¬ 
ditions  of  good  shades  at  small  cost.  Other  good  shades  will  be 
found  advertized  in  the  Sohool  Board  Journal. 

Statistics  given  later  and  the  writer rs  *wn  •bservations 
show  that  lighting  from  in  front  *f  the  pupils  is  still  permitted 
in  a  number  of  schools.  These  windows  should  be  immediately 
closed.  Appropriations  should  be  withheld  and  prosecution 
should  follow  if  necessary. 

Lighting  in  the  rear  #f  pupils  should  not  be  strong  enough 
to  injure  the  eyes  tf  the  teacher.  Small  high  windows  have 
■’-'roved  satisfactory,  or  long  windows  with  colored  glass  or  cur¬ 
tains  for  the  lower  sash. 

Fiunip;:  tion  of  schools  by  means  of  formaldehyde  or  other  chem¬ 
icals  is  probably  unnecessary  and  wasteful.  The  State  Board  of 
Health  officials  of  New  York  have  recommended  soap  and  water 
cleaning  instead.  In  fact,  cleaning  and  sunlight  are  gaining 
rapidly  in  favor  with  experts  in  this  field  over  older  methods 
of  disinfection  that  have  been'  brought  in  during  the  past  fifty 


-  "  ">  • . 


J  ,v 


■"  *« - - 


‘'.‘'J"  '•  r':f 


-  -  j. 


'  '-ry-v.-  «.v . 


•• 


' 


y 


W  . 


. 

. 


•  -  Qi  ..  . »w.,? 


*««*•*•  '  -v  >»  -  • 


13- 


years.  Fumigation  has  been  aptly  called  "burning  insence  to 
to  *ur  superstitions."  It  may,  however,  be  necessary  in  some 
cases  merely  to  allay  the  fears  of  parents,  but  soap  and  water 
scrubbing  should  accompany  it. 

I  have  seen  rural  schools  full  of  flies  in  my  visits. 

Desks  were  covered  with  remains  of  pupils’  lunches  and  the 
warmth  of  the  room  kept  the  flies  alive  till  late  in  the  fall. 

Such  teachers  may  teach  the  spread  of  infection  by  flies  when 
they  come  to  the  subject  in  the  hygiene  text-book  while  by  their 
neglect  they  may  be  spreading  disease.  A  few  five  cent  swr tiers, 
or  screen  wire  nailed  on  sticks  by  the  boys,  or  a  little  sweep¬ 
ing  of  the  ceilings  on  cold  mornings  would  have  eliminated 
these  disgraceful  pests.  In  one  case  the  flies  were  so  numerous 
that  one  to  three  or  more  could  be  seen  on  each  piece  of  pie  f  nd 
other  food  that  children  were  eating;  and  yet  a  county  superin¬ 
tendent  had  visited  the  school  without  comment  a  short  time 
previous  to  my  visit.  It  would  seem  that  a  campaign  of  school 
health  education  for  comity  superintendents  might  be  an  econom¬ 
ical  and  desirable  approach  to  the  rural  schooi  health  problem. 

An  examination  of  the  statistics  gathered  in  the  annual 
rural  school  sanitation  survey  as  given  later  will  show  the  need 
of  further  measures  along  lines  of  sanitation.  Dreat  care  should 
be  taken  in  providing  sanitary  privies.  Point  should  have  sand 
scattered  evenl?/-  on  it  while  fresh  so  markings  will  be  prevented. 
There  is  a  striking  dearth  of  paint  at  most  rural  schools  of 
frame  construction. 

Physical  Education.  Play  and  recreation  in  the  country  are  much 
needed  by  old  and  young.  The  rural  population  in  many  counties 
of  Pennsylvania  is  actually  decreasing  and  far  too  many  of  our 
youth  find  the  farm  a  dull,  sordid  place  of  all  work  and  no  play 
and  are  leaving  it  for  the  cities.  The  rural  school  should  meet 
or  help  meet  the  needs  of  rural  life  and  it  hern  a  fine  opportun¬ 
ity  at  this  point.  I  need  but  suggest  the  value  of  Curtis’  book 
on  Irplay  and  Hecreati#n  in  the  Open  Country”  at  this  point. 

Many  recreative  and  educational  games  and  plays  should  be  taught 
country  children;  apparatus  for  play  should  be  on  every  rural 
school  ground;  the  rural  school  should  be  made  an  evening  re¬ 
creational  center  for  old  and  young;  and  a  more  joyful  spirit 
should  pervade  the  school  life.  A  teacher  who  will  not  get  *ut 
on  the  playground  at  recesses  and  play  with  the  pupils  is  ^nly 
half  a  teacher.  For  her  own  health  and  poise,  and  for  better 
attainment  of  the  goal  of  life  she  should  regard  play  as  an  op¬ 
portunity.  Play  should  be  a  part  of  every  course  of  study  and 
teachers  should  be  trained  and  tested  along  the  lines  of  play, 
games,  recreations,  calisthenics  for  the  classroom,  the  construct¬ 
ion  and  use  of  play  apparatus. 

No  teacher  should  go  into  the  schools  from  normal  schools 
who  does  not  understand  how  to  lead  in  folk  dancing.  By  the  use 
of  movable  school  chairs  instead  of  desks  screwed  to  the  floor 
the  classroom  can  be  put  to  most  of  the  uses  of  a  small  gymnas¬ 
ium.  If  the  rural  school  is  to  be  used  as  an  evening  social  and 
recreation  center  there  is  no  reason,  except  the  narrow  pre¬ 
judice  and  traditions  that  are  driving  boys  and  girls  from  the 
farms,  to  keep  ftlk  dancing  out  of  the  rural  school  for  the  youth 


•o.. 


>4  li  rc ’r rrr sid n  be£l;3o  v.£$ci&  need  s&ii  tt*Co2%jjzx’'i'  ,h^:;9  •■ 

J  aauo.u  gii-.ij.j-  ^  ^ _ _ _ -v  4. 1  n  ,c>  r-«  :-->•  c-.-.r,  ;r„  ,-fro  -«•'•-  r  -*■ 


-<*: 


3  i  BJKi stc.o  :  '  —  ;  ’  -  *  !  :  *5 ;’. 


zosd  -i ‘  ^  -  ■"  —  ; 


p  ,  -  '  /N  r 


-14~ 


and  adults  of  the  neighborhood.  City  schools  have  long  had 
such  advantages.  One  hig  reason  frr  the  consolidated  school  is 
the  letter  opportunity  it  affords  for  such  a  social  and  re¬ 
creation  center  with  youth  in  attendance  in  sufficient  numbers 
to  make  some  social  life  possible.  To  eliminate  the  prejudices, 
we  need  wise  guidance  and  publicity.  Demonstrations  may  well 
be  held  at  every  county  institute.  The  use  of  pictures  of 
children  and  youth  engaged  in  such  plays,  games,  and  dances  will 
do  much,  to  make  them  gain  in  favor.  Let  us  lead  and  educate 
the  people  rather  than  attempt  merely  to  drive  them  by  legis¬ 
lation.  Legislation  is  good  but  education  is  better.  Both  are 
desirable. 


Specially  helpful  free,  or  free  for  the  pt stage,  bulletins :- 
Curtis,  "The  Reorganized  School  Playground"  (ten  cents),  Sunt, 
of  Documents,  Government  Printing  Office,  'Washington,  D.  Co 
State  Board  of  Education  of  Oregon , "AfcPractical  Recreation  Man¬ 
ual  for  Schools." 

State  Department  of  Public  Instruction  *f  Virginia.,  "Play  and 
Athletics  for  Virginia  Public  Schools. " 

Sfmnle  conies  tf  the  "Playground,"  a  monthly  magazine,  may  be 

obtained  at  the  Playground  offices,  No.  1  Madison  Avenue, 
New  York.  It  should  he  in  every  school  where  the  play- 
life  of  children  is  made  a  feature 

Most  rural  school  playgrounds  are  too  small  hut  few  are  well 
used  as  they  are.  The  excellent  work  done  by  several  county 
superintendents  of  Pennsylvania  in  organizing  play  festivals  and 
school  field  meets  as  well  as  organized  play  activities  at  the 
schools  are  worthy  of  wide  emulation. 

The  Teaching  of  Hygiene.  The  text-books  used  most  commonly  in 
the  rural  schools  are  not  the  best.  Older  texts  emphasizing 
principally  the  anatomy  and  physiology  of  the  human  body  are 
quite  common,  but  the  newer  books  dealing  with  how  to  live 
healthily  and  hapwily  in  this  world  are  making  their  way.  Me 
need  hygiene  books  especially  constructed  for  rural  schools. 

Since  each  township  selects  its  own  text-books  in  this  state, 
it  has  been  difficult  to  learn  of  the  actual  texts  that  are 
generally  used,  althoughquestions  asked  teachers  assembled  in 
several  oounty  institutes  seem  to  support  the  above  con¬ 

clusions. 

Teachers  should  learn  to  teach  hygiene  in  such  a  way  as  to 
create  habits  and  ideals  of  healthy  living.  B$  daily  question¬ 
ing  the  pupils  about  the  ventilation  of  their  sleeping  rooms, 
about  their  use  of  a  tooth  brush  and  visits  to  a  dentist,  about 
the  drinking  of  coffee  and  tea,  about  bathing  and  washing,  about 
bathing  and  washing,  about  hours  of  sleep,  about  their  food, 
and  many  •ther  matters,  a  teacher  may  gradually  change  the 
health  habits,  ideals,  and  standards  of  a.  community.  The  sug¬ 
gestions  given  in  Hoag  and  Terman's  book  previously  mentioned 
ere  helpful.  Every  case  of  sickness  of  the  pupils  and  every 
case  of  physical  defects  may  he  utilizer)  in  one  way  or  another 


V 


5  • 


i 


i  -* 


A 


-r 


-  rvrr  r  V  :/,«r  •• 


j! 


■  • 


15- 


without  offence  in  developing  right  rttitudes  toward  the  health 
problem  and  right  hr-hits  for  solving  it.  J- s  suggested  before, 
teachers  and  county  superintendents  and  supervisors  must  first 
be  e'uc;  ted  along  health  lines.  With  the  present  large  number 
of  valuable  bool's  there  is  no  excuse  for  ignorance  along  these 
lines.  /■  volume  on  school  health  can  be  read  in  &  few  evenings 
spent  as  concentratedly  as  teachers  read  novels. 

The  Hygiene  of  Instruction,  of  Methods  of  Teaching  and  Management. 
The  poor  arrangement  of  programs  of  study,  the  irritating  methods 
of  management  end  discipline,  the  lack  of  tact  end  control,  may 
all  be  means  of  lowering  the  tone,  mid  consequently  the  health, 
the  classroom.  Just  as  a  well  lighted,  end  well  tinted  room 
with  beautiful,  restful,  and  suggestive  decorations  may  be  a 
great  means  toward  joy  and  health,  so  may  the  teaoher’s  method 
of  teaching  and  management  be  a  benediction  or  its  opposite. 

Rooms  : nd  teachers  observed  seem  to  require  this  suggestion. 

In  general,  we  regret  the  lack  ff  data  and  the  lack  -'f  time 
for  the  preparation  of  this  study.  The  school  spirit  of  the 
rural  teachers  has  a  healthy  tone,  as  is  evidenced  by  the  appro¬ 
priation  for  the  expenses  of  the  survey;  good  work  is  being  done 
along  all  health  and  development  lines;  Pennsylvania  is  near 
the  front  in  this  work;  and  the  opportunity  before  the  teachers 
and  statesmen  of  the  state  at  the  present  time  is  very  great. 

With  further  investigation  and  co-operation  for  bringing  recom¬ 
mendations  to  pass  we  may  well  hope  to  lead  the  nation  in  this 
^rent  work.  EXHIBIT  A 

3/ HITARY  INSPECTION  OP  SCHOOLS  -  SESSION  1912-13 


Sanitary  Survey 

No,  tf  schools  inspec ted  7,375 

N*.  of  schools  unsanitary  6,730 

Np.  of  schools  sanitary  '  645 

30H001  BUILDING  NDIOBER 

Jifo.  of  individual  rooms  inspected  11,684 

'No.  of  rooms  having  sufficient  air  space  5,®25 

No.  of  rooms  deficient  in  air  space*  (fkotn^te : -*  on.  6,659 

ft.  not  given  in  16) 


Are  rooms  clean9 

Is  saw  dust  or  other  substance  used  with  a 
disinfectant  before  sweeping? 

Has  dry  dusting  been  absolutely  abandoned? 

Does  light  enter  in  front  of  seated  pupils? 

Does  light  surface  equal  20  per  cent  of 
floor  surface? 

If  pencils  or  ^ens  are  collected  are  they  re¬ 
distributed  so  as  to  insure  each  pupil 
getting  Jhis  •wn? 

If  "Plenum"  or  other  system  of  artificial  vent¬ 
ilation  is  used,  is  it  in  good  working  order? 

Are  some  wfp-dawo  oi™- —  —  ■  ■  ‘  "  -J  -  - 


•  •  •  «  • 

YES  NO 


11 ,  <129 
3,476 

389 

8,151 

4,787 

1,399 

6,776 

6  853 
10  *  131 
4,793 

5,663 

716 

3,228 

1,368 

n  cor 

369 

> 


'  ■  ■  •  7  ;  *■-••  *v'  “■ 


*5R5SC 


•  -VfWsr  ^^W***^ ' 


'^W 


•  . 


"SST  '-“9*r  - 


-.vw«r, 


-16- 


Yes 

lie. 

Are  some  windows  always  open  if  the  system  is 

3/695 

369 

nr t  in  full  operation? 

If  no  artificial  system  of  ventilation  is  used. 

5,663 

716 

are  some  windows  always  '•'pen  from  ton  or 
hottorn? 

/■re  ventilation  hoards  used  under  lover  sash? 

1 , 2-8 1 ' 

5,943 

Are  windows  open  during  recess? 

6,682 

562 

Are  yellow  or  linen  colored  shades  used? 

2,564 

4,594 

If  room  is  heated  with  stove  is  stove  jacketed? 

3  ,f  51 

3,141 

Is  cold  air  admitted  at  the  stove? 

1,149 

5,255 

Are  efforts  made  to  keep  air  of  room  moist? 

2,411 

4,7H 

/re  dustless  crayons  used? 

4,474 

2 , 3*4 

If  modern  heating  device  is  used,  is  it  a. 

direct  heating  system? 

1,262 

715 

If  indirect  heating  system  is  used,  do  cold 

1,471 

614 

air  ducts  receive  air  remote  from  lava¬ 
tories  and  water  closets? 

Are  adjustable  seats  used? 

1,535 

5,614 

If  seats  are  not  adjustable,  are  foot-stools 

618 

5,484 

provided  for  children  whose  feet  will  not 
touch  floor? 

Is  a  well  ventilated,  clean,  dry,  cloak  room 

2,666 

4,368 

pro  videcL? 
HATLjBj.  _ETC._ 


/re  the  halls  clean? 

2,674 

17* 

Are  they  'ell  lighted? 

2,78  r 

288 

/re  they  well  ventilated? 

2,773 

291 

Has  the  roller  towel  been  abolished? 

3,049 

1,770 

bo  the  emit  doors  onen  outward? 

1,554 

3,319 

Are  stairs  wide  and  straight? 

1 , 543 

449 

Are  exits  free  from  obstruction? 

4,124 

117 

Are  iron  fire  escapes  provided? 

"D/j  oy  .  y-.-  j  rji 

263 

2,137 

Is  the  basement  clean  and  dry? 

1,376 

263 

Is  the  'dumbing  modern-' 

041 

166 

Is  the  basement  veil  ventilate?  ' 

VAT OR  sir;?j:Y 

1/14 

287 

Does  the  school  have  its  own  local  water  supply? 

1,769 

5,363 

Is  it  apparently  pure? 

5,133 

256 

Is  it  protecte?  1  r nm  surface  drainers'3 

5,400 

889 

Is  it  free  from  cesspool,  privy,  vault  or 
manure  drainage? 

6,005 

285 

Is  water  stored  in  a  covered  container? 

2,397 

4,195 

Does  container  have  spigot  at  bottom? 

2,115 

3,736 

Is  the  container  scalded  daily? 

549 

5,421 

Is  a  fresh  supply  secured  each  session? 

5,149 

912 

Is  b  public  water  supply  used? 

1,255 

5,539 

Are  sanitary  drinking  fountains  provided? 

617 

6,«23 

Have  common  drinking  cups  been  abolished? 

2,6^6 

4,573 

Are  individual  drinking  cups  provided? 

3H0TJNLS 

2,111 

4,931 

Are  playgrounds  adequate  in  size  for  number 

6,395 

718 

•  f  pupils? 


/ 


■  •• ‘ r,'-» 


rrt‘*  -v  v*> 


/ 


•  **«; 


>7 


-17- 


7  re  the 7  well  drained? 

Is  there  evidence  §f  ground  pollution?  (is 
urine  or  feces  deposited ^ on  the  surface  *f 
the  ground. ) 

Is  garbage  nronerly  destroyed9 
'Are  there  rccuraulations  of  manure  Ar  #ther  re¬ 
fuse  in  vicinity  of  school  grounds7 
3M  A*E  hlSPOSAT 

7  re  separate  'ur  ivies  provided  for  each  sen? 

Are  the"  in  good  repair? 

Are  the  approaches  tightly  screened7 
Are  they  clean? 

Are  'eep  vaults  provided? 

Are  vaults  water  tight'’ 

Is  suface  drainage  excluded  from  nr  ivy 
contents? 

Is  lime  o r  other  disinfectant  used9 
/re  vaults  or  cesspools  filled  within  one 
foot  of  the  top? 

If  modern  flush  closets  are  provided,  do  they 
discharge  into  a  public  sewerage  system? 

Are  they  clean? 

ho  they  discharge  into  cesspools? 
ho  they  discharge  into  streams? 

're  soil  •  ices  carried  through  roof? 

EXHIBIT  h 


YES 

NO 

6  "63  8 

k/i  r\ 

K.  .XT 

282 

6,7  73 

6 , 711 

219 

176 

6,909 

7,056 

112 

5,214 

1,699 

3,398 

5,699 

5 , 250 

1,797 

3,071 

3,796 

1,771 

4,506 

7,054 

3 , 742 

2,675 

4,251 

1,169 

4,970 

273 

295 

46* 

62 

12* 

40  5 

164 

393 

321 

245 

DEATHS  OP  CHILDREN  0r'  SCHOOL  AGP  m  ^ENNSYLVANI/  ,  1912 
Selected  from  National  Mortality  Statistics 
Principal  causes  of  death  in  order  of  frequency  for  sum  of  all  age 


Lower  Elementary 

High  3  Grammar 

Total 

School  Age 

School  Age 

School  J 

5—9 

10—19 

5 — r 

Tc 

tals  for  all  ages  1 

,  202 

1 , 614 

2,816 

1. 

Accidents  (total) 

568 

749 

1,117 

2. 

Tuberculosis  (total) 

189 

895 

1 ,  *84 

r 

^  • 

Diphtheria 

497 

116 

613 

4. 

"'neumonia  ( to  tal ) 

148 

243 

591 

o  . 

Heart  Disease,  Organic 

1*1 

208 

589 

6. 

Tycho id  fever 

77 

254 

ooo 

7. 

Amend  icitis 

57 

189 

246 

8. 

Scarlet  fever 

152 

42 

194 

9. 

Broncho-  neumonia 

109 

48 

157 

10. 

Rheumatism,  articular 

55 

93 

148 

11. 

Meningitis  (total) 

61 

63 

124 

12. 

Bright ' s  disease 

35 

80 

115 

15. 

^uerneral  state 

0 

1*4 

104 

14. 

Endocarditis,  acute 

34 

63 

97 

15. 

Nephritis ,  acute 

42 

53 

95 

16. 

Measles 

68 

24 

92 

17. 

hiarrhea  ft  Enteritis 

66 

n 

87 

13. 

Diabetes 

15 

49 

64 

•■■■■-"  ••:,•,  ....  :  &  ■  - 


i 


■■  <••  ■■-,.■  •  .  v  -  •'••••;  ■  ■■  >/ ;.  •  > 


MA» 


19. 

£0. 

21. 

£2. 

2-V- 

2£. 

er>. 

26. 

27. 

28. 
29. 
80. 


18 

34 

52 

29 

23 

51 

9 

42 

51 

18 

32 

5* 

0 

48 

48 

i ; 

•50 

47 

29 

15 

44 

22 

22 

44 

22 

19 

41 

20 

15 

35 

10 

20 

30 

10 

14 

24 

10  ' 

“l 

"11 

uuse  s 

of  death 

of  children  of 

j  sen  c 

in  to  the 

State  Jje"  nr  Oj 

to  v'a 

shin gt on. 

1. 1  s ii 0"  3  cue 

Hernia ,  intestinal  Obs. 

Tetanus 
E-ilensy 

"'er itonitis ,  simple 
Suicide 

Hones,  diseases  oz 
Stomach  diseases,  o.t  ers 
S-'inal  cord,  other  dis. 

Cancer  (total) 

"'harynx ,  diseases  of 
Influenza 

Ears,  diseases  of  . . 

(Small  *. oxT  ’• 

Note:-  This  table  shows  tne 
are  according  to  the  diagnoses 

or  H-alth  and  by  it  forward e.  ^  .  . 

fi  -i  qpsqps  v/hich  ere  most  destructive  to  child  li.i-e  ^ 

The  means  of  Prevention  along  the  lines  of  education  develo"- 
inc-  bodilv  resistence  through  e:  ercise,  careiul  c.na  frequent 
s-ection  and  follow-up  nor1-,  looking  out  jor  carriers  ^  in¬ 
fectious  diseases  such  as  typnoid  an^  cm.--}!  hie.  is  ,  ane  Uo_.  o 
goinr  school,  home  and  co  inunit^  sani oe/cion, 
for  rural  schools  that  would  hel- 
its  urine i">al  life  problems. 


set ool 
ent 

thirtv 


,ese  a s, 


_  are  all  '  roblems 
the  rural’ population  to  solve 


HAH I BIT  C  _ 

Thirtv^seven  Causes  of  Heath  for  the  Entire  . emulation  m 
"  in  the  Rural  Histricts  of  Pennsylvania  and 
Arranged  in  order  of  frequency.  Tiie  tot. 

the  Rural  Histricts,  1912, 


cl  number  of 
v/ere  54, 219 


deaths  in 


Accord  in  <t  to  Fisher's  tables,  £S.X>«  #f  these  deaths  of  country 


Cities  are  define 
1,  Heart  disease 


deaths  of 

neonle  were  reasonably  preventable, 
as  municipalities  of  10,000  or  more  population 
rural  districts  'chose  vi  fch  less. 


2. 

5. 

4. 

5. 

6. 

7. 

8. 

9. 

10. 

11. 

12. 

15. 

14. 

15. 

16. 

17. 

18. 


•p . 

Ju\- 


,  organs. 

accidents 


4.880 

t.  cause  , 

Diarrhea  0  Enteritis  4,272 
Tuberculosis  4,249 

Early  infancy  other  di. 4,011 
/  -i c-pl e :.;y ,  oerehral  herwS-,  566 


Pneumonia  8 

Nenhritis,  acute  2 

Cancer  2 

Hr  one  .co  pneumonia.  1 

Stomach’,  other  dis.  1 

Hiphtheria  croup 
Old  age 

Ill  defined  diseases 
Bronchitis 
Mai forme ti on 
Typhoid 

.‘rteries,  diseases  of 

37.  EpiLepey 


479 

',593 

,504 

,942 

,024 

973 

881 

818 

789 

776 

681 

.880 


19. 

20. 
21. 
22. 

23. 

24. 

25. 

26. 

27. 

28. 
29. 
3  f . 

31. 

32. 

33. 
54. 
3  5. 
,38. 


Paralysis 

Convulsions 

Influenza 

'Tho oping  c^ugh 

Hiabetes 

I.leasles 

Hivsr ,  cirrhosis  of 
Hernia,  intestinal  ob. 
Meningitis 
Angina  pectoris 
Rheumatism  of  heart 
■Paralysis  «f  insane 
Spinal  cord  diseases. 
Pulmonary  congestion 
^er-peral  sentioemie 
Scarlet  Eever 
Appendicitis 
Liver,  other  dis.  «f 


565 

563 

506 

491 

471 

454 

455 
398 
A  67 
328 
259 
256 

oth. 244 
235 


207 

201 


'fSfP"  -  v-  • 


'  ! 


'  -  .  -  '  •  ".:  ■■■,, 


V,  ;  .  :X-C- 


'"’>3*505!*’' 


'a-  *rv 


fearal 


Fr^m 


rr«va  gohfcle  inspected  ..««  i  • 

Sf#,  schorl  roams  inspected*  .  •  .  •  •  •  • 

No,  nuT)il3  inspected  .«•••*  *••• 

N^.  nupils  defective 
No,  punils  not  defective. 


'A  '■ 


Districts 


7,375 
11,684 
3*5,372 
£28,693 
76f  679 


EARS 

Pupils  having  -defective  vision.  *  •  •  •  • 

No.  having  c June tivitis  simplex . 

No*  having  iritis  *.«••••«•• 

No.  having  trachoma 
HEARING 

*NoI  nurils  having  defective  hearing  «  *  . 
BREATHING 

No.  pupils  having  defective  breathing  ... 
No.  having  serious  impairment. 

No.  having  adenoids,  (suspeoted) 

TEETH 

No.  having  defective  teeth 

No.  having  unclean  teeth 

No.  having  decayed  teeth  •••.•«** 

No.  having  gums  diseased . . 

TONSILS  AND  GLARES 

No.  having  enlarged  tonsils . «  • 

No.  having  greatly  enlarged  tonsils.  •  • 

No,  having  acutely  inflamed  tonsils;  ;  ; 

No.  having  enlarger1  cervical  glands.  •  . 

TUBERCULOSIS 

No.  reported  as  having  tuberculosis.  »  • 
No.  reported- tuberculosis  of  Lungs  .  »  * 
Na,  reported- tuberculosis  nf  Glands  •  • 
[No.  rent,-  tuberculosis  of  Bones  &  Joints 
NERVOUS  PIS OASES 
Cllorea 
[  Euiler  sy 
SHIN  DISEASE 

No.  having  shin  affections  . 

Scabies . 

Impetigo  contagiosa,  .  • 

IPavus . 

Ring  Worm . . 

|  Nits  in  hair  . 

i  Head  lice  .  . . * . . 

|B*dy  lice  . 


27,686 

91,561 

928 


26,35ft 


192 

367 

76 


88 

260 

1 

58 

3,657 

11 

6 


82,454 

1,031 

27 

18 

8,818 

10,579 
2f  117 
4,454 

119,246 


87,2*2 

1,126 
19, 65^ 

635 


2& 
t , 

4,081 


74,69$ 

£5*11:?’ 

27,C*$ 


2,9  f$ 
3,4  0$ 


39, #5$ 
9.06^ 
29.98$ 


28, 5G$ 
8.6*% 

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* 


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DEI  ORMITIES 


No.  pupils  having  deformities  . 

Hunch  bach . 4t 

Club  foot  . -.50 

Curved  snine .  59 

AnlijaLosed  Joint  . .  13 

Hair  lip .  £9 

Cleft  ualate . 95 

Goitre.  . . 347 

Miscellaneous  .  . . .  .896 

NUTRITION 

No.  pupils  noted,  subnormal  in  nutrition 
No.  pupils  noted  fair  in  nutrition  • 11,463 
No.  pupils  noted  moor  in  nutrition  '  2,155 
JU  ARAN  T I N ABLE  DISEASE 

No.  pupils  in  school  that  should  have  been 

Chickenpox . * .  24 

Uhoo^ing-cough .  24 

Measles  .  ........  7 

Diphtheria . .  1 


1,589 


13,618 


in  quarantine  . •  57 


Teacher's  Follow-up- Uf*rk — Session  1912-1913 
Total  No.  of  letters  sent  parents  through  teachers  fili.OOl 

Total  No.  *f  teachers  sending  in  replies  at  end  of  term  7,375 

Total  No,  *f  rupils  covered  by  teachers'  replies  132,462 

Total  No.  of  pupils  reported  treated  30,099 

Total  No.  of  pupils  reported  improved  29,245 

Total  No.  of  defects  reported  improved  38,574 

Total  No,  of  ■;uv,'ils  not  treate’  87,220 

Total  No.  of  records  containing  no  ren*rt  15,143 


Eyes 


Reports  Concerning 


Eyes  ....  . 

Hearing . 

Breathing . 

Teeth . .  .  .  . 

Tonsils . 

Enlarged  cervical  glands 


Tuberoulosis 

lungs . . 

Bones .  . . 

Gla  nd  s  .  . . 

Joints  . 


Defects 

Not 

Improved 

Improved 

7, 023 

2,405 

1,052 

480 

1,47# 

784 

21,638 

1,778 

5,  #38 

3,173 

479 

243 

12 

3 

1 

1 

3 

• 

7 

0 

IN  CONCLUSION 

Ue  were  unable  to  obtain  frtm  the  State  , Board  #f  Health  the 
ren«rts  of  medical  and  sanitary  inspection  »f  rural  schools  for  the 
year  1913-14  and  s#  cannot  record  the  extensions  and  improvements 
in  this  time.  The  data  given  ab«ve  from  the  U. S.  Mortality  Statis¬ 
tics  and  from  our  state  reports  indicate, however , a  great  field  of 
opportunity  t«  help  the  people  of  the  country  to  meet  through  their 
public  sc'vols  this  great  and  largely  conquerable  monster  »f  pre¬ 
mature  death, inf ectious  and  other  illness, and  lowered  vital  efficiency. 

December  5,1914. 


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